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Background and Program Overview, Doctors Across New York (DANY), Physician Practice Support and Physician Loan Repayment Programs

Overview

Doctors Across New York (DANY) is a series of state-funded programs enacted in 2008 to help train and place physicians in a variety of settings and specialties to care for New York's diverse population. DANY programs include: Physician Practice Support, Physician Loan Repayment – including Residency Loan Repayment Tracks -- Ambulatory Care Training and other initiatives.

Physician Practice Support provides up to $100,000 in funding over a two-year period to applicants who can identify a licensed physician that has completed training and will commit to a two-year service obligation in an underserved region within New York State.

Physician Loan Repayment provides up to $150,000 in funding over a five-year period for physicians who commit to a five-year service obligation in an underserved region.

This document provides information on the Physician Practice Support and Physician Loan Repayment programs only; this is the third Cycle of funding for these programs.

Background

Although New York's physician-to-population ratio is currently above the national average, there are physician shortages in many communities and specialties. For example:

According to federal data, there are approximately 2.3 million New Yorkers who are identified as "underserved" for primary care services in New York's 99 area primary care HPSAs. It would require over 450 primary care practitioners in these areas to remove the shortage status.[1]

A majority of the primary care HPSAs (54%) are located in urban counties as defined by the New York State Legislative Commission on Rural Resources[2] and 74 or 46% of primary care HPSAs are located in rural counties. The primary medical care HPSAs largely have facility designations (43%), followed by population groups (37%), and geographic regions (20%).

A 2011 survey of the Healthcare Association of New York State members reported a need for more than 1,300 physicians of all specialties statewide, including over 385 in rural areas alone.

Other statistics demonstrate the need for physicians in other specialties across New York State. For example, twenty-five percent of practicing physicians in New York State are older than age 60; these retirements could worsen the current maldistribution of physicians in underserved areas.

In addition, in 2009, New York State had 65,936 active licensed patient care physicians; 20,278 or 31% were primary care physicians (family medicine, general internal medicine, or general pediatrics).[3] The ratio of full-time equivalent (FTE) primary care physicians to the population averaged 94 FTEs per 100,000 population statewide.[4] Although the density of primary care physicians statewide does not suggest a shortage in the aggregate, when compared to commonly used national ratios[5], New York State exhibits a maldistribution of primary care physicians in specific geographic regions, primarily in densely populated urban neighborhoods and rural communities, and in low-income and Medicaid populations. Physician supply varied across geographic region, ranging from a low of 70.5 FTEs/100,000 in the Mohawk Valley region to 100.6 FTEs/100,000 in New York City.[6] Between 2005 and 2009, the number of primary care physicians increased by 1,271 FTEs or 7% statewide.[7] Eight rural counties, however, lost primary care physician FTEs over the same period – Chemung, Chenango, Greene, Herkimer, Livingston, Seneca, Ulster, and Wayne counties.

By 2030, growth in demand for physicians in New York State will likely outpace growth in the supply of physicians. Using forecasting models adapted to include data specific to New York, in 2010, the Center for Health Workforce Studies concluded that between 2006 and 2030, growth in the demand for physicians in New York would likely outpace growth in the supply of physicians. The forecasts suggested that New York was likely to face a physician shortage in 2030, and, in the case of areas and populations already experiencing shortages, the intensification of current shortages. The forecasted gap between supply and demand growth would results in a shortage for between 2,500 and 17,000 additional physicians by 2030.[8]

The greatest gap between supply and demand growth statewide is projected in specialties that are forecasted to lose physicians over the period of forecast (2006-2030), including psychiatry, one of the primary care disciplines targeted by the Doctors Across New York program. The supply of psychiatrists is forecasted to decrease between 11.6% and 17.5%, depending on scenario assumption. Demand is projected to increase between 4.1% and 28%, resulting in a potential shortage of between 1,182 and 2,653 psychiatrists by 2030. Large gaps are also projected for specialties that are forecasted to experience a period a growth until 2020 and then decline by 2030, including general internal medicine, family medicine, and OB/GYN. Statewide physician shortages are predicted for general internal medicine (2,286-3,546), family medicine (595-1,011), and OB/GYN (24-355). In pediatrics, a discipline that is projected to grow more quickly than demand, a surplus of physicians is projected. On a regional basis, New York City and the Hudson Valley region (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester counties) are projected to experience potential gaps between physician supply and demand up to 14% by 2030. The resulting shortage of primary care physicians would range from 1,223 to 3,153 physicians in New York City and from 225 to 458 physicians in the Hudson Valley.

Table 1: Projected Differences Between Supply and Demand in New York State for Primary Care Specialties in 2030

Physician
Specialty

Baseline Supply
(2006)

Projected Supply
(2030)

Projected Demand
(2030)

Projected Surplus/(Shortage)
(2030)

General Internal Medicine

14,242

14,438- 17,289

17,096 – 18,357

(2,286) – (3,546)

Family Medicine

5,108

4,953 – 5,927

5,643 – 6,059

(595) – (1,011)

Pediatrics

5,939

6,464 – 7,740

5,901 – 6,336

1,404 – 1,839

OB/GYN

3,832

3,832 – 4,373

3,872 – 4,150

(14) – (355)

Psychiatry

6,166

5,236 - 6,166

6,420 – 7,891

(1,182) – (2,653)

The DANY programs recognize this need to encourage physicians to begin practice in underserved communities in New York State. Combined with other reimbursement reform efforts, the DANY initiative has begun to address areas of the state that currently lack diverse and adequate physician services.

In addition, DANY reflects the policy recommendations of the New York State Council on Graduate Medical Education in the report, Policy Recommendations to the Commissioner of Health, March 2008, and in the New York State Department of Health's (the Department's) report to the New York State Legislature (endorsed by the New York State Rural Health Council), Employment Incentives to Encourage Physicians and Nurse Practitioners to Practice in Rural, Underserved Areas, November 2007.

SFY 2012-13 Changes to the Program

A total of $1.7 million annually was approved in the 2012-13 New York State budget to fund the Physician Loan Repayment Program, and $4.3 million to fund the Physician Practice Support Program. These funds will support up to 20 additional Physician Loan Repayment awards, plus up to an additional 55 Practice Support slots.

In addition to continuing the funding for these programs, the 2012-13 State Budget included changes for the DANY Physician Practice Support and Physician Loan Repayment programs. The provisions are:

awards shall be made without a competitive bid or Request for Proposal (RFP) process;

a work group is to be established to develop a streamlined application process; and

the application process is to be clearer and more user-friendly. Applicants are to be able to access technical assistance provided by the Department, and timelines for acting on applications are to be streamlined; and

applications are now open to New York State-operated facilities.

To address these legislated changes, the Department assigned an existing Physician Workforce Planning Group (PWPG), originally created in 2007, to assist the Department in developing a streamlined application process. This group included associations representing physicians, general hospitals and other health care facilities. This group concluded its work in June 2012.

Program Information

Submission, Review and Award Process

Applications are currently being accepted for Physician Practice Support and Physician Loan Repayment only. There are three options to apply for funding:

Physician Practice Support to Establish or Join Practices – An individual physician can apply for funds to support the costs of establishing or joining a practice in an underserved community; or

Physician Practice Support to Recruit New Physicians - General hospitals and other qualified health care providers can apply for funds to help recruit new physicians to provide services in underserved communities. Funds may be used for sign-on bonuses, income guarantees or other financial incentives or compensation

In all three cases, funds must be provided directly to the physician. No administrative funding may be requested by facilities under any of the above options.

Applications will be accepted continuously beginning January 2, 2013 until March 29, 2013 or until funding is exhausted, whichever occurs first. Applications received before or after the posted dates or after funding is exhausted will be rejected and discarded, and the applicant will be notified of such.

Applicants should submit their applications electronically only (in PDF) to gme@health.state.ny.us – if impossible contact the Department at the number listed below.

You may contact Helen Crane at (518) 473-3513 (Physician Practice Support), Caleb Wistar or Martha Fennell at (518) 473-7019 (Physician Loan Repayment) for any assistance or clarification that may be necessary. An applicant conference will not be held for this project.

Applicants other than individual physicians (e.g., health care facilities and physician practices) may submit two applications per Operating Certificate (OpCert) or Federal Employer Identification Number (FEIN) during the entire application period of January 2, 2013 - March 29, 2013. No more than two DANY awards will be made to any one applicant of this type. To maximize the diversity of applicants, those planning to submit more than two applications are encouraged to collaborate with other applicants in the catchment or service area before applying.

Individual physician applicants may submit one DANY application each during the entire application period. No more than one award will be made to any one applicant of this type.

Applications will be time and date stamped upon receipt, and Department staff will review applications in the order in which they are received.

Applicants will be selected for an award if their applications are complete and meet the minimum threshold for an award, as described in the Instructions, and funding remains available within the category described below. It is anticipated that in Cycle III approximately 20 Loan Repayment (including Residency Loan Repayment Track) and 55 Physician Practice Support awards will be made during the 2012-13 State fiscal year.

Complete applications that meet all of the requirements will receive an award on a first-come first-served basis, contingent upon available funding. Ineligible expenses will be deducted from the amount of the award.

An applicant shall be notified in writing by the Department within 10 days of receipt of an application as to whether the application is complete or incomplete. If the application is incomplete, the Department will inform the applicant what information remains outstanding, and the applicant may submit missing information. The Department will act within 30 days of receipt of the complete application.

An applicant may withdraw an application at any time by notifying the Department in writing. An applicant who receives an award but is subsequently unable to fulfill the requirements of the award or resulting contract must also notify the Department in writing. Any applicant who submits an application that is deemed ineligible or who withdraws an application may submit a new application no sooner than the next state fiscal quarter, contingent upon available funding, until the per-applicant maximum has been funded. When funding has been depleted to a level such that an applicant's total requested funding amount cannot be met, the applicant will be offered a reduced award amount. If the applicant accepts that amount, no further awards will be made. If the applicant declines that amount, the next eligible applicant will be offered an award until funds are completely exhausted.

Applicants who do not receive an award may request a debriefing from the Department no later than three months from the date of the award announcement. This debriefing will be limited to the positive and negative aspects of the subject application.

Allocation of Funding

Based on statute, funding will be allocated as follows for each program:

Rest of State

Percent of Funding

Hospitals

33.35%

Non-Hospitals

33.35%

Sub-total, Rest of State

66.7%

New York City

Percent of Funding

Hospitals

16.65%

Non-Hospitals

16.65%

Sub-total, New York City

33.3%

Total, NYS

100%

Tax Issues

In the Patient Protection and Affordable Care Act (PL 111-148), Section 10908 addresses federal taxability of state loan repayment programs that are not part of the Federal State Loan Repayment (SLRP) program. This section puts the state loan repayment programs on par with the federal/state SLRP programs in terms of federal taxability. The text is as follows:

(a) IN GENERAL.—Paragraph (4) of section 108(f) of the Internal Revenue Code
of 1986 is amended to read as follows:

''(4) PAYMENTS UNDER NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM AND CERTAIN STATE LOAN REPAYMENT PROGRAMS.—In the case of an individual, gross income
shall not include any amount received under section 338B(g) of the Public Health Service Act, under a State program described in section 338I of such Act, or under any other State loan repayment or loan forgiveness program that is intended to provide for the increased availability of healthcare services in underserved or health professional shortage areas (as determined by such State).''

(b) EFFECTIVE DATE.— The amendment made by this section shall apply to amounts received by an individual in taxable years beginning after December 31, 2008.

Although loan repayment funds under the Physician Loan Repayment program are exempt from federal taxes, they still may be subject to New York State taxes. All funds from the Physician Practice Support program may be fully taxable. Please consult your tax professional for more information about your specific tax situation.

Administrative Requirements

This application is issued by the NYS Department of Health, Office of Primary Care. The Department is responsible for the requirements specified herein and for the review of all applications.

The Department of Health reserves the Right to:

Reject any or all applications received.

Withdraw the application any time, at the Department's sole discretion.

Make an award under this application in whole or in part.

Disqualify any applicant whose conduct and/or proposal fails to conform to the requirements of the application.

Seek clarifications and revisions of applications.

Use application information obtained through site visits, management interviews and the state's investigation of an applicant's qualifications, experience, ability or financial standing, and any material or information submitted by the applicant in response to the agency's request for clarifying information in the course of evaluation and/or selection under the application.

Prior to application opening, amend the application specifications to correct errors or oversights, or to supply additional information, as it becomes available.

Conduct contract negotiations with the next responsible applicant, should the Department be unsuccessful in negotiating with the selected applicant.

Utilize any and all ideas submitted with the applications received.

Unless otherwise specified in the application, every offer is firm and not revocable for a period of 60 days from the application opening.

Waive or modify minor irregularities in applications received after prior notification to the applicant.

Require clarification at any time during the procurement process and/or require correction of arithmetic or other apparent errors for the purpose of assuring a full and complete understanding of an offerer's application and/or to determine an offerer's compliance with the requirements of the application.

Negotiate with successful applicants within the scope of the application in the best interests of the State.

Eliminate any mandatory, non-material specifications that cannot be complied with by all applicants.

Award grants based on geographic or regional considerations to serve the best interests of the state.

Term of Contract

Any contract resulting from this application will be effective only upon approval by the New York State Office of the Comptroller and will be for a 24 or 60 month term, with an anticipated earliest start date on April 1, 2013.

Physician Loan Repayment Program applicants should note significant penalties will be instituted (see page 11) in the event the applicant cannot fulfill the full 5 year service obligation.

Payment Methods & Reporting Requirements

The contractor shall submit verification, on at least an annual basis, of the employment status of the obligated physician. All payment and reporting requirements will be detailed in Appendix C of the grant contract.

When requested, contractor shall report aggregate data on the demographics and socio-economic status of patients seen by the obligated physician.

When requested, the contractor shall report to the Department the use of all funds received under this contract.

The grant contractor will be required to submit vouchers and required reports of expenditures to the State's designated payment office:

New York State Department of Health
Office of Primary Care
Corning Tower, Room 1695
Albany, New York 12237-0001

Grant contractors shall provide complete and accurate billing vouchers, as appropriate, to the office noted above in order to receive payment. Billing vouchers submitted to the Department must contain all information and supporting documentation required by the contract, the Department and the State Comptroller. Payment for vouchers submitted by the contractor shall be made quarterly and shall only be rendered electronically unless payment by paper check is expressly authorized by the Commissioner, at the Commissioner's sole discretion, due to extenuating circumstances.

Such electronic payment shall be made in accordance with ordinary State procedures and practices. The contractor shall comply with the State Comptroller's procedures to authorize electronic payments. Authorization forms are available at the State Comptroller's website at www.osc.state.ny.us/epay/, by email at epayments@osc.state.ny.us or by calling 855-233-8363. The contractor acknowledges that it will not receive payment on any vouchers submitted under this contract if it does not comply with the State Comptroller's electronic payment procedures, except where the Commissioner has expressly authorized payment by paper check as set forth above.

Payment of such vouchers by the State (the Department) shall be made in accordance with Article XI-A of the New York State Finance Law. All payment and reporting terms will be detailed in Appendix C of the final grant contract.

Vendor Identification Number

Effective January 1, 2012, in order to do business with New York State, you must have a vendor identification number. As part of the Statewide Financial System (SFS), the Office of the State Comptroller's Bureau of State Expenditures has created a centralized vendor repository called the New York State Vendor File. In the event of an award and in order to initiate a contract with the New York State Department of Health, vendors must be registered in the New York State Vendor File and have a valid New York State Vendor ID.

If already enrolled in the Vendor File, please include the Vendor Identification number on the application cover sheet. If not enrolled, to request assignment of a Vendor Identification number, please submit a New York State Office of the State Comptroller Substitute Form W-9, which can be found on-line at: http://www.osc.state.ny.us/vendors/substitute_formw9.pdf or by referencing Attachment 12 (Statewide Vendor File Registration SFS Portal Format).

Vendor Responsibility Questionnaire

The New York State Department of Health recommends that vendors file the required Vendor Responsibility Questionnaire online via the New York State VendRep System. To enroll in and use the New York State VendRep System, see the VendRep System Instructions available at http://www.ocs.state.ny.us/vendrep/vendor or go directly to the VendRep system online at https://portal.osc.state.ny.us.

Vendors must provide their New York State Vendor Identification Number when enrolling. To request assignment of a Vendor ID or for VendRep System assistance, contact the Office of the State Comptroller's Help Desk at 866-370-4672 or 518-408-4672 or by email at ciohelpdesk@osc.state.ny.us.

Vendors opting to complete and submit a paper questionnaire can obtain the appropriate questionnaire from the VendRep website www.osc.state.ny.us/vendrep or may contact the Office of the State Comptroller's Help Desk for a copy of the paper form.

Applicants should complete and submit the Vendor Responsibility Attestation

General Specifications

By signing Section A, item 6, of the Application each signatory attests to his/her express authority to sign on behalf of the applicant.

The contractor will possess, at no cost to the State, all qualifications, licenses, and permits to engage in the required business as may be required within the jurisdiction where the work specified is to be performed. Workers to be employed in performance of this contract will possess the qualifications, training, licenses and permits as may be required within such jurisdiction.

Submission of an application indicates the applicant's acceptance of all conditions and terms contained in this application, including the terms and conditions of the contract.

An applicant may be disqualified from receiving an award if such applicant or any subsidiary, affiliate, partner, officer, agent or principal thereof, or anyone in its employ, has previously failed to perform satisfactorily in connection with public bidding or contracts.

In the event that a Physician Practice Support applicant receives an award and the physician identified on the application is no longer employed by the applicant, the applicant may select a replacement physician and receive the award funds if the following conditions are met: The physician must meet all of the program eligibility requirements, and must practice in the specialty, and at the site specified on the original application. The awardee must notify the NYSDOH and provide an employment contract for the replacement physician within 60 days.

Provisions Upon Default.

The services to be performed by the applicant shall be at all times subject to the direction and control of the Department as to all matters arising in connection with or relating to the contract resulting from this application.

In the event that the Contractor, through any cause, fails to perform any of the terms, covenants or promises of any contract resulting from this application, the Department acting for and on behalf of the State, shall thereupon have the right to terminate the contract by giving notice in writing of the fact and date of such termination to the Contractor.

If, in the judgment of the Department, the Contractor acts in such a way which is likely to or does impair or prejudice the interests of the State, the Department acting on behalf of the State, shall thereupon have the right to terminate any contract resulting from this application by giving notice in writing of the fact and date of such termination to the Contractor. In such case the Contractor shall receive equitable compensation for such services as shall, in the judgment of the State Comptroller, have been satisfactorily performed by the Contractor up to the date of the termination of this agreement, which such compensation shall not exceed the total cost incurred for the work which the Contractor was engaged in at the time of such termination, subject to audit by the State Comptroller.

Specific Provisions of this application:
If a Physician Practice Support Program obligated physician (the "Contractor") defaults on his/her service obligation, the Contractor will be responsible for repayment of any payments made under the contract to the State of New York, plus interest at the personal income tax late payment rate at the time of default, as follows:

Service of less than 12 months requires repayment of 100% of the total funds received.

Service of more than 12 months but less than 18 months requires repayment of 75% of the total funds received.

Service of more than 18 months but less than 24 months requires repayment of 50% of the total funds received.

If a Physician Loan Repayment Program obligated physician (the "Contractor") defaults on his/her service obligation, the Contractor shall repay the State of New York the greater of either $31,000 or the amount determined in accordance with the following formula:
The sum of:

The proportionate amount of the loan repayments paid by the State of New York to the CONTRACTOR representing any period of obligated service not completed; AND

$7,500 multiplied by the number of months of obligated service not completed; AND

Interest on the above amount calculated from the date of default at a rate equal to that owed on underpayments of New York State personal income tax

The CONTRACTOR will be notified of default via a demand letter and given the option of repayment of funds owed in one lump sum, or based on a repayment plan to be determined by the State of New York.

The STATE, by and through the concurrence of the Department of Health, the Office of the Attorney General, and the Office of the State Comptroller, reserves the right to postpone, change or waive the service obligation and repayment amounts in individual circumstances where there is compelling need or hardship due to circumstances beyond the control of the CONTRACTOR, which causes or is likely to cause CONTRACTOR's default under this contract.

Appendix A: Standard Clauses as required by the Attorney General for all State Contracts

Appendix A-1: Agency-Specific Clauses (Rev. 8/12)

Appendix B: Budget

Appendix C: Payment and Reporting Schedule

Appendix D: Program Workplan

Appendix X: Modification Agreement Form [to accompany modified appendices for changes in term or consideration on an existing period or for renewal periods]

Other Appendices

Appendix A-2: Program-Specific Clauses

Appendix E-1: Proof of Workers' Compensation Coverage

Appendix E-2: Proof of Disability Insurance Coverage.

Unless the CONTRACTOR is a political sub-division of New York State, the CONTRACTOR shall provide proof, completed by the Contractor's insurance carrier and/or the Workers' Compensation Board, of coverage for:

Workers' Compensation, for which one of the following is incorporated into this contract as Appendix E-1:

CE-200 - Certificate of Attestation For New York Entities With No Employees And Certain Out Of State Entities, That New York State Workers' Compensation And/Or Disability Benefits Insurance Coverage is Not Required; OR

C-105.2 -- Certificate of Workers' Compensation Insurance. PLEASE NOTE: The State Insurance Fund provides its own version of this form, the U-26.3; OR

Disability Benefits coverage, for which one of the following is incorporated into this contract as Appendix E-2:

CE-200 - Certificate of Attestation For New York Entities With No Employees And Certain Out Of State Entities, That New York State Workers' Compensation And/Or Disability Benefits Insurance Coverage is Not Required; OR

DB-120.1 -- Certificate of Disability Benefits Insurance OR

DB-155 -- Certificate of Disability Benefits Self-Insurance

NOTE: Do not include the Workers' Compensation and Disability Benefits forms with your application. These documents will be requested as a part of the contracting process should you receive an award.